Republic of the Philippines)

______________________) S. S.
x--------------------x

AFFIDAVIT OF ADVERSE CLAIM

I, _______________, of legal age, married, and with residence and post-office

address at _________________, after having sworn to in accordance with law hereby
depose and state:

1. That, I together with ___________are the only surviving heirs of my father,

the late _________. Copy of the death Certificate of my father is hereto
attached as Annex “A” and my birth certificate as Annex “B”;

2. That upon the death of my father, he left a house and lot situated at
_______________covered by TCT No. _________;

3. That as one of the heirs of the late ____________ I am entitled to my share

over the property;

4. That we have decided to partition the property to ourselves but the owner’s
duplicate copy is in the hands of ____________, older brother of my father
who refuses to surrender the title in my favor despite repeated demands;

5. That in order to protect my rights, interests, and participation over the said
property, I am hereto executing this affidavit of adverse claim;

6. That, I am executing this affidavit to attest to the truth of the foregoing, and to
request the Register of Deeds for ___________ to annotate the same and to
deny any and all request for conveyance over the said property without our
consent.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

____________, hereat _______________.

__________________________

SUBSCRIBED AND SWORN to before me this _______________, hereat

__________________.

Notary Public
Doc. No. _____
Page No. _____
Book No. _____
Series of 20___